Women Still Missing from Medicine’s Top Ranks

The newly renovated suite of offices for our medical department was beautiful – clean, sleek lines that nevertheless incorporated features of the century-old hospital. The chairman of the department had a new office there, as well as all the division chiefs and the main administrators of the department. It was a plum location.

But there was one slight logistical problem: The stalls in the otherwise lovely women’s bathroom were narrow, and all the doors opened inward. For the women who carried bags or purses with them, this arrangement was annoying. For me, pregnant at the time, it was the Berlin Wall.

Upon witnessing my daily struggle to wedge myself and my soon-to-be-born offspring into the stall, my female office mates began a petition to reverse the bathroom doors. Admittedly there are more pressing needs in medicine, but the administrators, secretaries and members of the clerical staff rallied to the cause, and eventually victory was achieved just before my son was born. We even had a party to celebrate the now-famed reversal of the doors. All the women from the suite attended.

It was at the party that I noticed that of all the women who worked in that suite of 30-odd offices, I was the only physician; every other woman was administrative. As I mentally surveyed the men who had offices in the suite, all but one were doctors, and all were in the upper echelons of the department.

We certainly had plenty of female doctors on the faculty, but it was striking to me that in the main suite of the department, the gender lines were stark. The men were senior faculty members, and the women, other than me, were administrative.

This phenomenon is well documented. While women make up about half of all medical students and a third of academic faculty, they are sorely underrepresented in the upper ranks. A recent review in The Journal of General Internal Medicine showed that only 19 percent of full professors are women. Only 12 percent of department chiefs are women. In the survey, men and women were engaged in their work to a similar degree, and both groups had comparable aspirations for leadership roles.

But over all, women did not feel the same sense of inclusion in the medical world as men did. They were not confident about their ability to be promoted, despite their interest in advancement. These findings do not come as a surprise to most women in medicine.

Is it that the medical world remains biased against women, despite the increasing number of women in the ranks? Or is it, as some have postulated, that the culture of the workplace – built around the needs of men for generations – simply remains that way? Despite trends toward more equitable distribution of family responsibilities and more child care services, women still shoulder more of the family burden. For most people, peak career-building years overlap with peak family-building years.

There is also the idea of “possible selves.” If you see lots of women who are doctors, a teenager can imagine that for herself as a possible life. But if you never see any women leading a department, it’s much harder for a junior faculty member to envision that job as a possibility.

No one I’ve spoken to feels there is much deliberate bias in medicine these days. But the lingering unconscious bias involving the various waves of newcomers – women, members of racial and ethnic minorities, gays and lesbians – resonates for many.

Our department has come a long way in the past 10 years. Women are a third of the faculty, though only 12 percent have attained the level of associate or full professor. (For our male counterparts, 30 percent have reached that level.)

There are more female doctors in the office suite now, some of whom are division chiefs. There are female physicians directing the clinics and the residency programs. But on a national level – as reflected in this recent article – most women feel that they aren’t in the inner circles and, more concerning, feel that they aren’t likely to ever get there.

I worry most about what our students and residents draw from this. Do they sense the improvements, even if modest – or do they see a lack of “possible selves” in the upper ranks and direct their energy elsewhere?

The bathroom doors in the women’s room have opened outward for a decade now, so the pregnant staff members at all levels can make their way in. It’s a start, but there’s still a long way to go.